Spondylolisthesis is a condition of the spine where one vertebrae segment moves forward abnormally both in flexion (rotation) and translation relative to the vertebra immediately below it. This may be due to (a) torn soft tissue restraints (ligaments, joint capsules, etc.), (b) eroded and deformed joints (degenerating spondylolisthesis), or (c) a defect in the bone between the lamina, spinal process and transverse process as one unit and the rest of the vertebrae as a second unit (spondylolytic spondylolisthesis).
When spondylolisthesis is present, the upper vertebral segment moves anteriorly in a saggital plane both in an angular flexion, as well as a straight translational direction. Generally, treatment of spondylolisthesis corrects both types of displacement so that the flexion and translation of the upper element and the relative extension of translation of the lower element are both corrected to restore the normal lordotic alignment of the lumbar spine.
One way to treat spondylolisthesis is to reduce the deformity with a pair of longitudinal plates attached at each level S-1, L-5 and L-4 by means of pedicle screws, (e.g., Roy Camille plates or variable slotted plates (Steppe plates.) Since the pedicle screws are angled medially in line with the long axis of the pedicle, the distance between the tips of the screws and the position where the screw will ultimately attach to the plate is different. Another difficulty with longitudinal plates is aligning multiple screws inserted at different pedicle angles even if no reduction is performed. A third problem is that reducing using only longitudinal plates is much weaker than reducing with two pedicle screws pre-connected with a transverse connecting plate. Longitudinal plates also place a large mass of metal over the facet joints where they restrict the ingrowth of blood vessels into the healing fusion and thus inhibit bone formation. The mass of the plates and screw attachment is also in the middle of the paraspinal muscles (instead of between the muscles) creating more dead space and scar tissue.
It is desirable to have a system for treating spondylolisthesis that provides secure fixation of the lower lumbar region of the spine and effectively reduces the accentuated curvature resulting from spondylolisthesis. Such desirable system would also include a plate design that does not interfere with the paraspinal muscles. Furthermore, it would be desirable if the system would allow for adjustment of the positional relationship between the plates and the pedicle screws so that optimum plate placement could be maintained before, during, and after reduction.